The role of contractual arrangements in improving health sector ...

Jordan
CONCLUSIONS AND RECOMMENDATIONS
Conclusions
The results of the study show that the Ministry of Health has at least 8 formal contracts or
agreements for purchasing health services, 5 with private hospitals and 3 with autonomous public
providers. Six contracts were reimbursed according to fee-for-service and two contracts were
paid a fixed payment against leasing a specific number of hospital beds (Al-Mowasah and Al-
Hayah hospitals). In addition to these formal contracts, the Ministry of Health has informal
contracts with private hospitals to admit insured patients in case of emergency. About 38 000
Ministry of Health enrollees were admitted to the hospitals with which the Ministry has formal
and informal contractual agreements. The total annual cost for these admissions is about JD 28
million, with an average cost of JD 535 per admission.
The Ministry of Health, with the support of PHRplus, is implementing a Health Insurance
Pilot Project (HIPP). The main objective of this project is to expand the administrative and
technical capacity of the Ministry of Health in the areas of contract design, contract monitoring,
and contract enforcement. Obstetric services constitutes the preliminary bundle of services to be
contracted under the HIPP, and payment will be according to a fixed price per episode. Several
steps have been taken prior to implementation of the project, such as: the establishment of
implementation unit, development and testing of computerized MIS, development of clinical
guidelines and protocols and preparing final contracts. The qualification process was completed
recently and bidding documents will be distributed to the qualified hospitals very soon.
The results of the study showed that most of the contractual arrangements have positive
impacts on the purchaser (the Ministry of Health) and the providers (private and autonomous
public hospitals). As this report shows, contracting has improved access, efficiency,
sustainability, promoted public health goals, and created an environment conductive to public–
private collaboration. Although there is no evidence base, the quality of contracted services is
likely to be satisfactory. This may be attributed to the fact that most of the contracted hospitals
have highly skilled and well trained health personnel, advanced medical equipment and
advanced diagnostic facilities, and have achieved a good medical reputation both inside and
outside Jordan.
On the macroeconomics level, contracting out services is successfully being used by the
government as a social and economic policy tool in dealing with the effects of poverty and
unemployment. Indeed, the admitting of 38 000 insured patients outside the Ministry of Health
facilities in 2003 for example, has provided almost equal number of admissions for uninsured
poor patients in the Ministry of Health hospitals nearly free of charge. Utilizing some of the idle
beds in the private sector will reflect positively on the government’s efforts to contain the rising
health care expenditures and encourage the private health sector to grow and participate
effectively in the national economy.
141